PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “outbreak”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources

Genetic characterisation of African swine fever viruses from outbreaks in southern Africa (1973-1999).

African swine fever (ASF) is a highly lethal and economically significant disease of domestic pigs in the southern African sub-region, where outbreaks regularly occur. There is anecdotal evidence suggesting that trans-boundary movement of infected animals may have played a role in precipitating widespread outbreaks in the past, however, since the 1970s outbreaks have generally been more localised, particularly in those countries where control of animal movement is strictly regulated. The origin and relatedness of regional ASF outbreaks was investigated here by means of a two-step genetic characterisation approach whereby p72 gene sequencing was used to delineate genotypes, prior to intra-genotypic resolution of viral relationships by central variable region (CVR) characterisation of the 9RL ORF. In this manner, regional virus heterogeneity and epidemiological links between outbreaks could be assessed for the first time through phylogenetic analysis of the C-terminal end of the p72 gene of viruses recovered from domestic pig outbreaks in southern Africa between 1973 and 1999. The phylogeny revealed the presence of 14 distinct p72 genotypes of which 6 (genotypes XVII-XXII) were considered novel. Eight of these were country-specific with the remaining six having a trans-boundary distribution. CVR products were heterogeneous in size ranging from 377bp to 533bp across the 14 southern African genotypes. Within-genotype CVR comparisons revealed the presence of a genotype XIX virus with an extended field presence in South Africa (1985-1996) and permitted discrimination between three genotype VII viruses that were identical across the p72 gene.

Africa, Southern↗

Poliomyelitis in Oman. I. The last outbreak?

Since 1988, the Sultanate of Oman has experienced three outbreaks of paralytic poliomyelitis. The last outbreak occurred in December 1993 and involved two children aged 10 months and 4 1/2 years. The children had received five and four doses, respectively, of trivalent oral polio vaccine (OPV) and lived in the same village. Serum neutralizing antibody tests suggested that paralytic polio in these children was due to poor antibody response to OPV. Wild poliovirus type 1 was isolated from both patients, as well as from seven of ten close contacts of the older child, and one of eight contacts of the younger child. All contacts had received three to six doses of OPV. Genomic sequence studies indicated that the virus isolates belonged to a genotypic group prevalent in southern and western Asia, but differed markedly from virus isolated during the 1988/89 outbreak, suggesting another importation of poliovirus. In response to the outbreak, supplementary immunization with OPV was given to children <6 years of age, initially in the affected district, and subsequently to children in the whole country. This study demonstrates that immunization with three to six doses of OPV did not prevent infection with wild poliovirus. In those children with sub-optimal response to OPV, infection resulted in paralytic poliomyelitis. The outbreak remained localized in one village, indicating that the outbreak control measures were effective.

Antibodies, Viral↗

Application of genetic methods to study the relationship between classical swine fever outbreaks.

Eleven viruses isolated between 1993 and 1997 from outbreaks of classical swine fever in the neighbouring countries of Slovakia, The Czech Republic and Austria were compared after partial sequencing of the NS5B and E2 genes. Viruses collected from South-Central and West Slovakia were indistinguishable during a period of four years, even when associated with outbreaks of variable severity. Outbreaks that occurred in the Czech Republic in 1996 involved two types of virus, one of which was related to the Slovakian outbreaks, and the other to Austrian outbreaks. The results show that the molecular-genetic approach can reveal epizootiological relationships between outbreaks that would not otherwise be apparent. Furthermore, the relative genetic stability of the classical swine fever virus in the field, means that quite small sequence differences can have epizootiological significance.

Animals↗

Detection of Serratia outbreaks in hospital.

Infections due to Serratia marcescens were studied in 23 different hospitals. A retrospective study was done in 4 hospitals; all isolates were compared by serological typing, antibiograms, bacteriocin production, and bacteriocin sensitivity. 2 of the hospitals were having cross-infection problems due to antibiotic-resistant strains, but the other 2 had little or no cross-infection. Outbreaks were studied in 19 other hospitals. 9 of these outbreaks were classified as "common source" since contaminated "sterile solutions" were incriminated as the cause in each. One hospital had a "pseudo-outbreak," in which Serratia from E.D.T.A. blood-collecting tubes contaminated blood-cultures as they were collected. All 10 of these strains from common-source outbreaks were generally sensitive to antibiotics. Outbreaks in 9 other hospitals resulted from cross-infection and were caused by strains which were very resistant to antibiotics. Guidelines for detecting outbreaks are given and control measures are suggested.

Alabama↗

Simultaneous isolation of verotoxin-producing strains of Escherichia coli O128:H2 and viruses in gastroenteritis outbreaks.

Three outbreaks of gastroenteritis from which the Verotoxin producing Escherichia coli serotype O128:H2 was isolated are reported. In addition Norwalk-like viruses were detected in patients from two of the outbreaks and astrovirus in the third outbreak. While it cannot be specifically determined which of these agents played the major role in these outbreaks, the findings suggest that the viral agents need to be considered in investigations of gastroenteritis outbreaks, regardless of whether bacterial enteropathogens have also been isolated. This study points to a strong need to investigate gastroenteritis outbreaks for both bacterial and viral agents and to review in detail the asymptomatic carriage rate of Verotoxin-producing bacteria and gastroenteritis-associated viral agents; these areas of public health significance have been largely neglected.

Australia↗

The effect of an outbreak of respiratory disease on herd-level milk production of Norwegian dairy farms.

This study was done to evaluate the effect of an outbreak of acute respiratory disease associated with bovine respiratory syncytial virus (BRSV) on the daily milk yield per cow in Norwegian dairy-cattle farms. Retrospective data from 184 dairy herds located in two neighbouring veterinary districts during the study period (December 1994-May 1995, during which an epidemic of acute respiratory disease associated with BRSV occurred in this area) were analysed. Data on the bulk-milk deliveries and the date of the outbreak were collected at herd level, whereas information on calving dates and parity was collected at cow-level. The effect of the herd outbreaks on the daily milk yield was analysed with a repeated-measurement approach. The average daily milk loss was estimated to be 0.70kg per cow for 7 days after a herd outbreak (compared with the period >1 week prior to an outbreak), adjusted for the herd-level lactation stage, parity and their interaction term. We consider the estimated milk loss associated with a herd outbreak of epidemic respiratory disease to be of minor importance.

Animals↗

An outbreak of an unusual strain of Serratia marcescens in two Dublin hospitals.

We describe a serious outbreak of infection caused by a strain of Serratia marcescens in two Dublin hospitals which occurred over an 11 week period and affected a total of 15 patients. A contaminated bed-pan macerator in the Intensive Care Unit of one hospital was identified as the possible source of infection and spread of the organism probably occurred via hand transmission by hospital personnel and via patient transfer to a second hospital. All isolates of S. marcescens involved in the outbreak had the same antimicrobial susceptibility pattern, with reduced susceptibility to gentamicin, cefotaxime and ciprofloxacin. Epidemiological typing revealed that the strains of S. marcescens isolated in the outbreak were of an uncommon serotype, O21:K14, and using pulsed-field gel electrophoresis, XbaI DNA macrorestriction profiles clustered at 90% similarity. The DNA patterns of the outbreak strain were also highly similar to S. marcescens isolates of the same serotype recovered from a separate Dublin hospital during the same time period as the outbreak described here. In addition, the isolates clustered at 82% similarity with strains of the same serotype from a retrospective collection of S. marcescens isolates from various hospitals in the Dublin area, indicating that these may be genetic variants of the same strain. Although the outbreak was brought under control following implementation of infection control measures, a significant number of similar O:21 isolates of S. marcescens have since been identified in four Dublin hospitals. These results suggest the unique spread of a single strain of S. marcescens in Dublin hospitals.

Cross Infection↗

Clostridium difficile: an update on its epidemiology and role in hospital outbreaks in England and Wales.

Data from the surveillance system of general outbreaks of infectious intestinal disease and from laboratory reports collated by the Communicable Disease Surveillance Centre (CDSC) and requests for outbreak investigation by the PHLS Anaerobe Reference Unit were used to evaluate the current epidemiology of Clostridium difficile infection in England and Wales. Between January 1992 and December 1996, CDSC received 10,220 laboratory reports of C difficile isolation from patient's faeces and 26,873 of toxin in faeces. Over 75% of all reports were of people aged 64 years and over. The surveillance system captured a minimum data set on 694 hospital outbreaks of infectious intestinal disease. C. difficile was responsible for 109 (15%) outbreaks affecting 1625 people, of whom 1152 were found to have a C. difficile toxin producing strain. The median duration of outbreaks was 11 days. Fingerprinting by Pyrolysis Mass Spectrometry (PMS) was performed by the PHLS Anaerobe Reference Unit in 60 outbreaks, and typing by Polymerase Chain Reaction ribotyping (PCR) in 14.

Adolescent↗

Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel's definition and management guidelines.

OBJECTIVE: To provide medical personnel with a definition of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and guidelines for managing potential outbreaks. PARTICIPANTS: Eighteen panel members were chosen from different specialties, types of institutions, and geographic regions. Representatives from the American Society of Consultant Pharmacists, the American Society of Health-Systems Pharmacists, the Society for Healthcare Epidemiology of America, and the National Association of Directors of Nursing Administration participated. CONSENSUS PROCESS: In preparation for the conference, panel members reviewed the literature and wrote abstracts outlining their personal opinions on the core issues, which were circulated to all participants. During a weekend conference, the panel summarized the reviewed literature, defined an MRSA outbreak, and developed management guidelines. EVIDENCE: Published literature, clinical experience, and expert opinion concerning the emergence and subsequent management of MRSA cases in health care institutions. RESULTS: An outbreak of MRSA was defined as either an increase in the rate of MRSA cases or a clustering of new cases due to the transmission of a single microbial strain in the health care institution. An increased rate of cases can be defined statistically or experientially and includes both infected and colonized patients. A potential outbreak should trigger stepwise, multidisciplinary actions consisting of basic epidemiologic procedures (phase I) to form an initial epidemiologic hypothesis of an outbreak (phase II) followed by a standard epidemiologic workup (phase III) and microbiologic studies (phase IV) to confirm the hypothesis. Mupirocin calcium treatments should be considered to decolonize health care workers during the fourth phase, even before typing is completed. CONCLUSIONS: Until studies can be conducted to delineate the effectiveness of different recommendations, the proposed guidelines may provide a useful starting point that can be adapted to meet an individual institution's specific needs.

Disease Outbreaks↗

Halting a pneumococcal pneumonia outbreak among United States Marine Corps trainees.

BACKGROUND: Streptococcus pneumoniae is the leading cause of bacterial pneumonia in all age groups. Identifying outbreaks of pneumococcal disease and key risk factors may lead to improvements in vaccination and prevention strategies for high-risk groups. A significant outbreak of S. pneumoniae pneumonia that occurred among Marine recruits is reported here. METHODS: An outbreak was investigated using standard microbiologic procedures and epidemiologic evaluation to define the extent of the outbreak, determine the microbiologic causative agent(s), identify risk factors for the development of disease, and institute preventive measures against further cases of pneumonia among recruits. RESULTS: Fifty-two cases of radiographically confirmed pneumonia occurred among 3367 Marine recruits over a 2-week period in November 2000. Twenty-five of these cases occurred in a single company of 481 men, with an attack rate of 5.2%. Twelve of the 25 cases were caused by S. pneumoniae, serotypes 4 and 9v. The outbreak rapidly ended following isolation of cases, prophylaxis with oral azithromycin, and administration of the 23-valent pneumococcal vaccine. CONCLUSIONS: This outbreak of pneumococcal disease occurred in the setting of intense military training and a crowded environment. The use of the pneumococcal vaccine year-round in military trainees and other high-risk populations to reduce pneumococcal disease should be considered.

Adolescent↗

Costs of a hepatitis A outbreak affecting homosexual men: Franklin County, Ohio, 1999.

BACKGROUND: Hepatitis A is one of the most commonly reported, vaccine-preventable diseases in the United States. Many cases occur in association with community-wide outbreaks, but societal costs to the community are seldom documented. METHODS: Hepatitis A case-patients available for a follow-up interview as part of an outbreak investigation were asked about hospitalization, healthcare costs, missed work, and lost wages associated with their illness, as well as healthcare insurance coverage and sick-leave reimbursement. Average costs were calculated by case-patient age, gender, and hospitalization status for lost wages, and by age and hospitalization status for medical costs, and then assigned to case-patients not re-interviewed to provide an estimate of overall costs. Health departments provided outbreak-associated costs. RESULTS: Between the weeks of November 2, 1998, and May 17, 1999, a total of 136 cases of hepatitis A were reported. Of the 89 (65.4%) case-patients available for interview, 74 (83%) were male; of those, 47 (64%) identified themselves as men who have sex with men (MSM). The average cost of the outbreak per case-patient was $2894 US dollars, of which 51% was associated with lost wages, 40% with medical costs, and 9% with health department costs. Case-patients incurred 44% of total outbreak costs; employers, 29%; healthcare insurers, 18%; and health departments, 9%. CONCLUSIONS: In this community-wide hepatitis A outbreak, case-patients incurred the largest portion of costs, followed by employers, healthcare insurers, and health departments.

Adolescent↗

[Nosocomial influenza outbreak in a geriatrics department: Effectiveness of preventive measures].

OBJECTIVE: To describe a nosocomial influenza outbreak and the pharmacologic and nonpharmacologic control measures implemented in a hospital ward with beds for acute geriatric care and rehabilitation care. METHODS: Descriptive survey conducted in the geriatrics department of a university hospital. An influenza outbreak occurred in February 2005 in 2 of the department's 3 separate units. The study concerned all patients in the 2 affected units (A and B) present during the outbreak, as well as all department staff. Once cases of influenza were confirmed, elderly patients in contact with influenza patients received chemoprophylaxis with oseltamivir when it became available. RESULTS: Thirty-eight (76%) patients and 62 (38%) staff members had been vaccinated. The time from the initial symptoms of the first case until implementation of control measures was 7 days in unit A but only 1 day in unit B, -and chemoprophylaxis of contact patients began in 9 days and 24 hours respectively. The attack rate was 38% in the 38 vaccinated patients and 29% in the 14 unvaccinated patients (NS). All cases met the definition of nosocomial infection. No deaths imputable to influenza occurred during the outbreak. The implementation of the nonpharmacologic measures aimed at preventing spread of the outbreak presented no particular difficulty, except for compliance with geographic isolation of some patients with dementia and influenza. The difference between the attack rates for the two sectors (48% for unit A and 28% for unit B) suggests that the preventive measures were effective. Tolerance to chemoprophylaxis with oseltamivir was good. CONCLUSION: This study confirmed that influenza can affect elderly hospital patients, even those in whom the vaccination rate is high, and that rapid detection of the outbreak and immediate implementation of pharmacologic and nonpharmacologic preventive measures can limit its spread.

Aged, 80 and over↗

A new variant of echovirus 4 associated with a large outbreak of aseptic meningitis.

BACKGROUND: A large outbreak of aseptic meningitis which began in April 1997 involved hundreds of cases in all geographical regions of Israel and the Palestinian Authority, peaked between June and September, and lasted until December. OBJECTIVES: We have investigated the virus associated with the outbreak to determine its serotype and molecular type and to establish epidemiological links. DESIGN: Virus strains isolated from 210 clinical samples were serotyped by neutralization using LBM and WHO antiserum pools and two echovirus 4 (EV4)-specific antisera, and by immunofluorescence using a monoclonal antibody. RNA was extracted and a 435 base long fragment derived from the 5'UTR of the genome was amplified by RT-PCR using common primers, and sequenced. Sequences were compared to echoviruses 4, 6 and 7 prototypes from ATCC, and to other echoviruses sequences from the EMBL/Genbank data base. RESULTS: The outbreak isolates were identified by the EV4 type-specific antisera and the monoclonal antibody but not with the WHO pools. Very few isolates could be typed by the LBM pools. The EV4 isolates accounted for 68% of all enterovirus isolates in our laboratory in 1997. The age distribution of the patients was: 0-11 month, 11.2%; 1-4 years, 16.1%; 5-9 years, 31.8%; 10-14 years, 9.9%; 15-20 years, 9.5%; 21-44 years, 21.5%; and > 45 years, 0%. Males between 1 and 14 years of age were affected more frequently than females of the same age. The sequences of 25 of 28 EV4 isolates analyzed were closely related to each other (> 95% homology) and the remaining three isolates had < 95% homology to the others and to each other. Interestingly, the outbreak strains were less closely related to the EV4 prototype, than to several other echoviruses. Three closely related subgroups were identified which correlated with geographical distribution but the temporal distribution did not reveal links leading to the source of the outbreak. CONCLUSION: The outbreak was caused by a variant of EV4 which apparently did not circulate in the area before and thus was capable of causing a widespread infection.

Disease Outbreaks↗

[Hepatitis A outbreak in a day care center and household transmission].

BACKGROUND: An outbreak of hepatitis A occurred in a day care center in Madrid between October 2002 and February 2003 and spread to the children's families. PATIENTS AND METHODS: We performed a descriptive study of this outbreak and of the control measures adopted. RESULTS: The outbreak affected 23 people: eight children aged 1-3 years (attack rate= 8.7 %), two staff members (attack rate=10.5 %), and 13 household contacts. Of the 23 cases, 17 were confirmed by serology and eight patients were hospitalized. The control measures were: (i) increasing general hygiene measures in the home and school and, in particular, those concerning diaper changing by staff, and (ii) vaccination of all pupils aged more than one year (92 children), staff members (16 adults) and family contacts of affected individuals. After vaccination, the epidemic curve showed intrafamilial transmission exclusively. Cases among familial contacts affected adults in contact with asymptomatic children. CONCLUSIONS: Vaccination was effective in controlling the epidemic outbreak within the day care center. However, when outbreaks occur, vaccination should be prescribed to close contacts of all the children, whether symptomatic or not, especially parents and siblings. The recommendation that day care center workers undergo vaccination on taking up their posts should be put into practice, since vaccination is not systematically performed. General vaccination would be the most effective measure for preventing outbreaks in educational centers.

Adult↗

Outbreaks of diarrhoeal illness on passenger cruise ships, 1975-85.

We reviewed data from the Vessel Sanitation Program (VSP), established by the US Public Health Service in 1975, to describe the epidemiology of shipboard diarrhoeal outbreaks, determine the risk of outbreak-related illness among cruise ship passengers, and evaluate changes in rates and patterns of shipboard diarrhoeal illness since the VSP was implemented. When the programme began, none of the cruise ships passed periodic VSP sanitation inspections; since 1978, more than 50% of ships have met the standard each year. On cruises lasting 3-15 days and having at least 100 passengers, diarrhoeal disease outbreaks investigated by the Centers for Disease Control decreased from 8.1 to 3.0 per 10 million passenger days between 1975-79 and 1980-85. The proportion of outbreaks due to bacterial pathogens (36%) did not change. Seafood cocktail was implicated in 8 of 13 documented food-borne outbreaks. The risk of diarrhoeal disease outbreaks on cruise ships appears to have decreased since implementation of the VSP but has not been eliminated.

Diarrhea↗

A comparison of Salmonella enteritidis phage types from egg-associated outbreaks and implicated laying flocks.

Infections due to Salmonella enteritidis are increasing worldwide. In the United States, between 1985 and 1989, 78% of the S. enteritidis outbreaks in which a food vehicle was identified implicated a food containing raw or lightly cooked shell eggs. Under a US Department of Agriculture regulation published in 1990, eggs implicated in human food-borne S. enteritidis outbreaks were traced back to the source flock. The flock environment and the internal organs of a sample of hens were tested for S. enteritidis. We compared the S. enteritidis phage types of isolates from 18 human, egg-associated outbreaks and the 15 flocks implicated through traceback of these outbreaks. The predominant human outbreak phage type was recovered from the environment in 100% of implicated flocks and from the internal organs of hens in 88% of implicated flocks we tested. The results support the use of phage typing as a tool to identify flocks involved in human S. enteritidis outbreaks.

Animals↗

Public health implications of campylobacter outbreaks in England and Wales, 1995-9: epidemiological and microbiological investigations.

Although campylobacter has been the most commonly recognized bacterial cause of gastrointestinal infection in England and Wales since 1981, there are few reported campylobacter outbreaks. Of the 2374 general outbreaks of infectious intestinal disease reported to CDSC between 1995 and 1999, for which an aetiological agent was identified, campylobacter accounted for only 50 (2%). Foodborne transmission was identified in 35 outbreaks and the majority took place in commercial catering establishments; waterborne transmission was responsible for a further four outbreaks. Isolates of Campylobacter jejuni were referred for typing from 25 outbreaks. In 13 outbreaks all isolates were the same subtype, as defined by serotype and phage type, while in the remainder more than one campylobacter subtype was involved.

Adolescent↗

A boarding school outbreak of pertussis in adolescents: value of laboratory diagnostic methods.

Culture for Bordetella pertussis (B. pertussis) is the traditional gold standard for laboratory diagnosis of pertussis but is insensitive, especially later in the course of illness and in vaccinated persons. Interpretation of serology is limited by the lack of an appropriate reference standard. An outbreak of pertussis in a crowded boarding-school dormitory allowed evaluation of laboratory correlates of infection. Questionnaires, serum samples and throat swabs were collected from members of the exposed group. Serum samples from unexposed controls of a similar age group were used for comparison. B. pertussis PCR was performed on throat swabs, and sera were tested for IgA antibodies against whole-cell (WC) B. pertussis antigen and IgG antibodies to pertussis toxin (PT). The Centers for Disease Control and Prevention definition for pertussis was used to define clinical cases. We evaluated the use of a previously published cut-off for PT IgG of 125 EIA units (EU)/ml. Completed questionnaires were obtained from 115 students, of whom 85 (74%) reported coughing symptoms, including 32 (28%) who met the clinical case definition for pertussis. B. pertussis was detected by PCR in 17 (15%) and WC IgA in 22 (19%) students; neither correlated with symptoms, but dormitory of residence strongly predicted PCR status. The mean PT IgG geometric mean concentration, in this situation of high pertussis exposure, correlated with severity of symptoms and was significantly higher in both symptomatic and asymptomatic children exposed during the outbreak (P < 0.001) than in control children. A cut-off for PT IgG of 125 EU/ml was too high in an outbreak situation to be sensitive enough to identify pertussis cases. A case of pertussis in a crowded boarding-school dormitory resulted rapidly in an outbreak. Serology and PCR were useful in identifying the outbreak and commencing disease control measures. The use of serology has mostly been evaluated in community serosurveys, where it is not possible to determine if immunity reflects vaccination, asymptomatic disease or symptomatic disease. This outbreak gave us the opportunity to evaluate the value of serology and PCR in the presence of confirmed exposure to pertussis.

Adolescent↗